JP2022543041A - Bile Drainage Mechanism for Retrograde Percutaneous Biliary Drainage Maintaining Negative Pressure - Google Patents

Abstract

The present invention relates to a biliary drainage mechanism for negative pressure maintaining retrograde percutaneous biliary drainage, comprising: The biliary drainage mechanism for negative pressure-maintaining retrograde percutaneous biliary drainage (NR-PTBD) performed during the course of pancreaticoduodenectomy involves the afferent small intestine to aspirate bile. A flexible tube having an inhalation port formed at one end that sits in an adjacent loop, and a tube inserted through a biliary tract cut so that the tube can penetrate liver tissue. It is characterized by including guide members provided at the side ends.

Description

The present invention relates to biliary drainage mechanisms for retrograde percutaneous biliary drainage that maintain negative pressure, and more particularly to negative pressure to reduce afferent small bowel pressure during the course of pancreaticoduodenectomy. The present invention relates to a biliary drainage mechanism for retrograde percutaneous biliary drainage that maintains negative pressure so that retrograde percutaneous biliary drainage that maintains a negative pressure can be performed simply and safely.

Pancreaticoduodenectomy (pancreatoduodenectomy, pancreatoduodenectomy, Whipple procedure, or Kausch-Whipple procedure) is a basic operation in the surgical treatment of tumors in the pyloric region of the duodenum. Pancreatic-jejunal anastomosis requires a high degree of surgical skill, and the mortality rate due to leakage of this anastomosis has been reported to be 25-30%, with an incidence of 10-20%. In addition, many hepato-biliary-pancreatic surgeons in Japan and abroad have made various attempts to prevent leakage at the pancreas-jejunal anastomosis, but there is still no definitive answer.

Attempts to reduce pancreatic-jejunal anastomosis leakage can be broadly classified into two categories. The first is a method of strengthening the anastomosis of the anastomosis. For example, studies comparing Dunking anastomosis to mucosa-mucosal anastomosis have also been conducted, and in some cases pancreas-gastrointestinal anastomosis was attempted instead of pancreatic-jejunal anastomosis, but no meaningful results were derived. I didn't. The second is to reduce afferent small bowel loading and reduce pressure. Several reports have indicated that attempts to reduce afferent small bowel loading by percutaneous biliary drainage performed before or after surgery are meaningful.

Recently, when performing pancreaticoduodenectomy, negative pressure-retrograde installation of percutaneous transcutaneous biliary drainage (NR-N) has been used to reduce pancreatic-jejunal anastomotic leakage. PTBD) has been developed and attempted by the inventor. As shown in FIG. 1(a), retrograde percutaneous biliary drainage that maintains such a negative pressure can As shown in FIG. 1(b), a wire 4 with a blunt tip is inserted into the opening of the biliary tract 2 and exposed to the surface of the liver 1, and penetrates the liver 1 as shown in FIG. 1(c). After connecting the end of the suction tube 5 to the tip of the exposed wire 4, as shown in FIG. pull through. After that, an inhalation tube 5 of about 10 to 15 cm is placed in the afferent loop so that pancreatic juice, bile, intestinal juice, etc. can be inhaled, and a drainage bag connected to the inhalation tube 5 from the outside of the body. (Jackson-Pratt drains, not shown) to provide a negative pressure to the inhalation tube 5 to drain pancreatic juice, bile, intestinal juice, etc. to the outside of the body, thereby reducing pressure in the small intestine.

However, in the retrograde percutaneous biliary drainage that maintains negative pressure performed in the course of pancreaticoduodenectomy, in the process of pulling the wire 4 that penetrates the tissue of the liver 1 to guide the suction tube 5, the wire 4 The problem of separation of the suction tube 5 from the is frequently encountered. When the suction tube 5 is separated from the wire 4 while passing through the liver tissue, the wire 4 is used to pass through the tissue of the liver 1 again, and after the suction tube 5 is reconnected to the tip of the wire 4, the wire 4 is reconnected. The tissue of the liver 1 can be damaged excessively because the process of pulling the suction tube 5 out of the opening of the biliary tract 2 must be repeated.

On the other hand, in order to prevent such a problem, the connecting portion of the wire 4 and the suction tube 5 may be tied with a string so that the fixed state can be firmly maintained. is performed in the upper part of the liver, that is, in a narrow space between the liver 1 and the diaphragm 3, not only does the operation take a long time, but it also requires a high degree of skill.

SUMMARY OF THE INVENTION Accordingly, it is an object of the present invention to solve such conventional problems by providing a retrograde meridian that maintains negative pressure to reduce pressure in the afferent small intestine during pancreaticoduodenectomy. An object of the present invention is to provide a biliary drainage mechanism for retrograde percutaneous biliary drainage that maintains a negative pressure, which allows simple and safe percutaneous biliary drainage.

The above object is achieved according to the present invention in a biliary drainage mechanism for negative pressure-maintaining retrograde percutaneous biliary drainage (NR-PTBD) performed during pancreatoduodenectomy, which is required to aspirate bile. A flexible tube having an inlet formed at one end for resting in the afferent loop, and a tube inserted through a biliary tract cut so that the tube can penetrate liver tissue. This is accomplished by a biliary drainage mechanism including a guide member provided at the other end of the .

Here, it is preferable that the guide member is rod-shaped.

Further, it is preferable that a plurality of guide grooves for bending or cutting the guide member are formed along the longitudinal direction of the guide member.

Further, it is preferable that the tip of the guide member is curved or bent.

Also, it is preferable to further include a needle provided after removing the guide member from the tube so that the other end of the tube can penetrate the skin after penetrating the liver tissue.

In addition, it is preferable that the needle has a pointed end formed at its front end, and a coupling part fixed to the tube is formed at its rear end.

In addition, the apparatus further includes a drainage bag provided after the needle is removed from the tube so as to contain bile discharged through the tube after the other end of the tube penetrates the skin. is preferred.

Also, it is preferable that the drainage bag is formed in the form of an elastic valve so as to provide a negative pressure to the suction port.

According to the present invention, in the course of a pancreaticoduodenectomy, maintaining a negative pressure to reduce the afferent small bowel pressure maintains a negative pressure that allows retrograde percutaneous biliary drainage to be performed simply and safely. A biliary drainage mechanism for retrograde percutaneous biliary drainage is provided.

In addition, since the guide member that penetrates the liver tissue and exits to the outside can be easily bent or cut, the guide member that penetrates the liver and is discharged into the narrow space between the liver and the diaphragm can be easily handled. A biliary drainage mechanism for retrograde percutaneous biliary drainage is provided that maintains a stable negative pressure.

In addition, the direction in which the guide member penetrates the liver can be easily controlled by bending the tip of the guide member penetrating through the liver tissue in one direction. A biliary drainage mechanism for percutaneous biliary drainage is provided.

1 is a schematic diagram showing a negative pressure-maintaining retrograde percutaneous biliary drainage performed during a conventional pancreatoduodenectomy; FIG. 1 is a perspective view showing the configuration of a biliary drainage mechanism for retrograde percutaneous biliary drainage maintaining negative pressure according to the present invention; FIG. Using the biliary drainage mechanism for retrograde percutaneous biliary drainage maintaining negative pressure of the present invention, retrograde percutaneous biliary drainage maintaining negative pressure performed in the course of pancreaticoduodenectomy is performed. 1 is a schematic diagram showing FIG. Figures 10A-10D illustrate various embodiments of guide channels for the biliary drainage mechanism for retrograde percutaneous biliary drainage that maintains negative pressure of the present invention;

In order to expose the flexible tube 10 fixed to the rear end of the guide member 20 to the outside of the liver 1 , the entire guide member 20 must come out of the liver 1 . At this time, when the operator bends or cuts the guide member 20 using the guide groove 21, the entire guide member 20 exits the very narrow space between the liver 1 and the diaphragm 3. 20 can be prevented from contacting the diaphragm 3 .

The guide groove 21 can be configured in various forms according to usage environments and applications. For example, as shown in FIG. 4(a), when the guide groove 21 is recessed in one side of the guide member 20 in a direction crossing the guide member 20, the guide member 20 can be easily bent in one direction. As shown in FIG. 4(b), when the guide grooves 21b are recessed on both sides of the guide member 20 in the direction crossing the guide member 20, the guide member 20 may be cut off. , can be bent in any one selected direction, and as shown in FIG. can be cut easily. Such a guide groove 21 is preferably formed within a range in which the guide member 20 is not arbitrarily bent by the guide groove 21 while the guide member 20 penetrates the tissue of the liver 1 .

The needle 30 is fixed to the other end of the tube 10 so that the tube 10 can penetrate the skin 6 from the inside to the outside, and the needle 30 can penetrate the skin 6 at its tip. A sharp point 31 is formed, and a connecting part 32 that can be inserted and fixed to the other end of the tube 10 is formed at the rear end.

Meanwhile, the tip 31 may be bent in one direction so that it can penetrate the skin 6 in a narrow space. In addition, the coupling part 32 is configured to be inserted into and fixed to the other end of the tube 10, and the outer peripheral surface of the coupling part 32 is configured so that the fixed state with the tube 10 can be firmly maintained. can be provided with a number of ring wedges.

The drainage bag 40 has the needle 30 removed from the tube 10 so that it can contain the bile that is drained through the tube 10 after the other end of the tube 10 penetrates the skin 6 . It is installed after the suction port 11 and may be in the form of a valve having elasticity to provide a negative pressure to the suction port 11 .

Operation of the first embodiment of the biliary drainage mechanism for retrograde percutaneous biliary drainage maintaining negative pressure described above will now be described.

As shown in FIG. 3(a), the tip of the guide member 20 fixed to the end of the tube 10 is inserted into the opening of the biliary tract 2 cut by the pancreaticoduodenectomy, and the guide member 20 is moved in the insertion direction. When pushed, the distal end portion 22 of the guide member 20 inserted through the opening of the biliary tract 2 penetrates the tissue of the liver 1 and is exposed to the outside of the liver 1 .

At this time, since the distal end portion 22 of the guide member 20 is bent in one direction, the direction in which the guide member 20 penetrates the tissue of the liver 1 is guided in the direction in which the distal end portion 22 is bent. . Therefore, the practitioner can cause the guide member 20 to penetrate the tissue of the liver 1 in a desired direction while rotating the guide member 20 in the axial direction.

Subsequently, as shown in FIG. 3(b), in a state where the distal end portion 22 of the guide member 20 penetrates the tissue of the liver 1 and is exposed to the outside, the distal end portion 22 of the guide member 20 is pulled and the guide member 20 is pulled. A tube 10 connected to the rear end of the liver 1 can be passed through the tissue of the liver 1 .

According to the present embodiment, the guide member 20 is exposed to the outside of the liver 1 because it can be bent or cut using a plurality of guide grooves 21 formed along the longitudinal direction of the guide member 20 . By bending the guide member 20 using the guide groove 21, the diaphragm 3 is prevented from being damaged by the guide member 20 exposed outside the liver 1 in the narrow space between the liver 1 and the diaphragm 3. can be done. In this embodiment, the guide member 20 is described as being bent by the guide groove 21, but it can be cut as necessary.

As shown in FIG. 3C, when the guide member 20 is completely exposed to the outside of the liver 1, the tube 10 connected to the rear end of the guide member 20 passes through the liver 1. As shown in FIG. In such a state, the end of the tube 10 is cut, the guide member 20 is removed from the end of the tube 10, and the connecting portion provided at the rear end of the needle 30 is removed as shown in FIG. 3(d). 32 is secured to the end of tube 10;

When the needle 30 is completely fixed to the end of the tube 10, as shown in FIG. 3(e), the tip 31 of the needle 30 is used to pierce the skin 6, and the needle 30 is pulled from the outside of the body to extend the tube. The end of tube 10 can be exposed outside the body, and needle 30 is removed from tube 10 by cutting the end of tube 10 after the end of tube 10 is exposed outside the body.

Subsequently, as shown in FIG. 3( f ), a drainage bag 40 is provided at the end of the tube 10 from which the needle 30 has been removed, and one side of the tube 10 extended through the opening of the biliary tract 2 is removed. The ends are placed in the afferent loop of the pancreatic-jejunal anastomosis, followed by pancreaticoduodenectomy to suture the pancreas and biliary tract 2 and the gastrointestinal tract, respectively, to the small intestine.

After pancreaticoduodenectomy is completed, when negative pressure is applied through a drainage bag, bile, pancreatic juice and intestinal juice are discharged from the body through an inlet 11 formed at one end of the tube 10. Therefore, leakage of the pancreatic-jejunal anastomosis can be effectively prevented by reducing afferent small bowel loading and reducing pressure.

According to the present embodiment as described above, the guide member 20 is used to allow the tube 10 inserted into the opening of the biliary tract 2 to be retrograded to the outside of the liver 1, thereby performing pancreaticoduodenectomy. Retrograde percutaneous biliary drainage that maintains negative pressure during

In addition, since the guide member 20 that passes through the tissue of the liver 1 to the outside can be easily bent or cut, the guide member 20 can be pulled out of the narrow space between the liver 1 and the diaphragm 3 to facilitate the operation. It is possible to prevent the difficulty from increasing.

The scope of rights of the present invention is not limited to the embodiments described above, but can be embodied in various forms of embodiments within the scope of the appended claims. Without departing from the gist of the invention claimed in the scope of claims, the description of the scope of the invention can be modified to various extents by anyone having ordinary knowledge in the technical field to which the invention belongs. Considered to be within range.

Claims (8)

In a biliary drainage mechanism for negative pressure-maintaining retrograde percutaneous biliary drainage (NR-PTBD) performed during pancreaticoduodenectomy,
A flexible tube formed at one end with an inlet for resting in the afferent loop for inhaling bile, and a tube inserted through a biliary tract cut through the liver tissue. a biliary drainage mechanism for retrograde percutaneous biliary drainage that maintains negative pressure including a guide member provided at the other end of the tube to allow for The biliary drainage mechanism for retrograde percutaneous biliary drainage maintaining negative pressure according to claim 1, wherein the guide member is rod-shaped. [Claim 3] The retrograde percutaneous biliary system according to claim 2, wherein a plurality of guide grooves for bending or cutting the guide member are formed along the longitudinal direction of the guide member. Bile drainage mechanism for drainage surgery. The biliary drainage mechanism for retrograde percutaneous biliary drainage maintaining negative pressure according to claim 2, wherein the tip of the guide member is curved or bent in one direction. 2. The negative pressure maintaining device of claim 1, further comprising a needle provided after removing the guide member from the tube so that the other end of the tube can penetrate the skin after penetrating the liver tissue. biliary drainage mechanism for retrograde percutaneous biliary drainage. [Claim 6] The retrograde percutaneous biliary drainage maintaining negative pressure according to claim 5, wherein the needle has a pointed end formed at a distal end and a connecting part fixed to the tube formed at a rear end. Bile drainage mechanism for liquid surgery. 4. Further comprising a drainage bag provided after the needle is removed from the tube so as to contain bile that is drained through the tube after the other end of the tube penetrates the skin. 6. A biliary drainage mechanism for retrograde percutaneous biliary drainage that maintains negative pressure according to 5. [8] The retrograde percutaneous device for maintaining negative pressure according to claim 7, wherein the drainage bag is formed in the form of an elastic valve so as to provide negative pressure to the suction port. Biliary drainage mechanism for biliary drainage.

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